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Treatment and management

If you are diagnosed with polycystic ovary syndrome (PCOS), it’s important to work with your doctor and a medical team to manage your symptoms and improve your long-term health outcomes.

Women with PCOS may have a range of symptoms that require different treatments. Depending on your symptoms, you can seek help from a range of healthcare professionals, including an endocrinologist, gynaecologist, dietitian, dermatologist, exercise physiologist, fertility specialist and psychologist.

Your doctor can help coordinate your care and refer you to specialists where needed.

Learn how to treat and manage common PCOS symptoms.

Topics on this page

Irregular or no periods

With PCOS, high levels of androgens (male-type hormones) and insulin can disrupt your monthly cycle of ovulation and periods. This means your periods may be irregular or stop altogether.

The average menstrual cycle is 28 days, but ‘normal’ cycles can range from 21 to 35 days.

An irregular cycle is defined as:

  • eight or fewer menstrual cycles per year
  • menstrual cycles shorter than 21 days
  • menstrual cycles longer than 35 days.

For teenagers, an irregular cycle might mean periods:

  • are longer than 90 days (more than a year after periods have started)
  • are shorter than 21 days or longer than 45 days (between one and three years after periods started)
  • have not started by the age of 15.

When menstrual cycles lengthen, ovulation can stop or only happen occasionally.

Healthy lifestyle

A healthy lifestyle is the most effective approach to managing PCOS symptoms, including irregular periods. A healthy lifestyle includes eating a balanced diet, maintaining a healthy weight, being as active as possible and reducing or stopping harmful habits such as smoking and excessive drinking.

Learn more about how physical activity and diet can help improve PCOS symptoms.

Medicines

Your doctor might recommend different medicines to re-establish regular periods.

Hormonal contraception

Depending on your symptoms and health, your doctor may suggest:

  • the combined oral contraceptive pill (the Pill)
  • progesterone, which stimulates the uterus and induces bleeding
  • hormonal implants
  • vaginal contraceptive rings
  • intrauterine devices (IUDs) that contain progesterone.

The oestrogen and progesterone in hormonal contraception override your body’s menstrual cycle.

The Pill reduces the production of hormones such as testosterone and other androgens (male-type hormones), which may improve symptoms such as excess hair.

Hormonal contraceptives may have some side effects.

For example:

  • mood changes
  • weight gain or loss
  • bloating
  • breast tenderness
  • irregular bleeding.

There may also be some risks, especially if you smoke, have high blood pressure or are extremely overweight.

Metformin

Metformin reduces insulin resistance and the production of androgens in the ovaries. It is more likely to benefit women with PCOS who have a heavier weight.

Metformin is not as effective as the Pill at making periods more regular. But it has a more positive effect on cholesterol levels and insulin than the Pill. It also helps with weight loss and reduces the risk of diabetes in people at high risk. Metformin has few serious side effects.

In some cases, Metformin can also improve how the ovaries work, re-establish regular periods and increase fertility.

It is important to discuss these medicines, their side effects and risks with your doctor before making any decisions.

Hair and skin conditions

Excess hair on your face and body, scalp hair loss (alopecia) and acne are symptoms of PCOS.

Many women feel distressed by these visible symptoms, but you can try different treatment options.

Excess hair

You can wax your excess hair, use laser hair removal or electrolysis. Laser hair removal is more likely to reduce hair growth over time, but you need regular treatments which can be costly.

Some dermatologists specialise in laser hair removal for women with PCOS. They can recommend the best treatment for your hair and skin type.

Scalp hair loss

You can use minoxidil (sold as Rogaine and Regaine) to prevent hair loss. The liquid or foam is massaged into your scalp. Some dermatologists prescribe minoxidil tablets. Side effects include scalp dryness and itchiness.

Acne

You can treat acne with creams or gels that reduce pore blocking, oil production and inflammation. Ask your doctor which products they recommend.

Dermatologists may prescribe isotretinoin to help with acne. This should only be prescribed for women who are not trying to get pregnant, as the medicine can cause birth defects. Side effects include dry skin and eczema.

It is widely accepted that diets with a high glycaemic load (GL) contribute to acne. Glycaemic load is the effect of carbohydrates on blood sugar levels. A high-GL diet can increase oil production in skin cells, causing acne. The Australasian College of Dermatologists recommends a low-GL diet to help manage acne.

Learn more about eating a balanced diet.

Medicines that reduce androgen production

Certain medicines reduce the production of testosterone and other androgens in the body, which may improve symptoms such as excess hair, scalp hair loss and acne.

For example:

  • the oral contraceptive pill
  • anti-androgen drugs
  • spironolactone (sold as Aldactone)
  • cyproterone acetate (sold as Androcur)

As with all medicines, there may be risks and side effects, so it’s important to work with your doctor to find the best treatment for you.

Stress, anxiety and depression

Stress, anxiety and depression are common in women with PCOS. These conditions are often overlooked and left untreated. But emotional health is just as important as physical health.

Symptoms of PCOS, such as excess hair growth and acne, can make some women feel self-conscious, reduce their self-esteem and affect their body image and mood. If you get help to manage your physical symptoms, it may improve your emotional health.

Body image is the way you think or feel about your body. Many women with PCOS feel less physically attractive. This can be difficult to cope with emotionally.

Also, the process of getting a diagnosis and living with a condition such as PCOS can be distressing.

These factors may cause stress, anxiety and depression. But there are things you can do to take care of your emotional health.

Having a healthy lifestyle (a balanced diet and physical activity) is an effective way to improve your mood and reduce negative feelings. There are also many natural and complementary therapies you can try.

But if you have constant and extreme negative feelings and thoughts that stop you from doing everyday activities, see your doctor. They may refer you to a counsellor or psychologist for support. In Australia, you can get Medicare rebates for seeing a psychologist.

If counselling and other therapies aren’t working, talk to your doctor about medicines that may help.

Watch this video featuring psychologist Dr Mandy Deeks, who explains why feelings of anxiety and depression occur more commonly in women with PCOS, and what you can do about it.

Weight

Weight gain is a common concern for people who have been diagnosed with PCOS. It can be hard to manage your weight if you have PCOS. This includes maintaining a healthy weight or losing weight if needed. For women who have a higher weight, even a small weight loss can make a difference. Weight loss helps your ovaries to function better and may result in normal hormone production, which will improve symptoms.

Research studies have shown that a weight reduction of 5% to 10% can:

  • reduce insulin resistance by about 50%
  • restore ovulation
  • regulate menstrual cycles
  • improve fertility
  • reduce pregnancy complications
  • improve the health of mother and child during pregnancy
  • improve emotional health (self-esteem, anxiety, depression)
  • reduce the risk of developing diabetes and heart disease.

Risks of abdominal obesity

With PCOS, excess weight is more likely to be concentrated around your abdominal (stomach) area.

Abdominal obesity is associated with:

  • a higher risk of insulin resistance
  • a higher risk of type 2 diabetes
  • a higher risk of cardiovascular disease, including high blood pressure, heart disease and stroke
  • fertility problems
  • anxiety and depression.

Checking your abdominal weight

To measure your waist circumference accurately, measure yourself without clothing and position a tape measure around your body roughly in line with your belly button. Breathe out normally, making sure the tape is snug but not too tight, and take the measurement.

The recommended waist circumference for adult women is about 80 cm.

Measuring your BMI

You can also measure your Body Mass Index (BMI) to check if you are a healthy weight. BMI = weight (kg) ÷ height (m) squared.

For example:

Sally weighs 90 kg and is 1.67 m tall. Her BMI is 32.3

90 ÷ (1.67 x 1.67) = 32.3

  • A BMI of 18.5 to 24.9 is classified as a healthy weight.
  • A BMI of 25 to 29.9 is classified as overweight.
  • A BMI of 30 or more is classified as obese.

How to lose weight

Healthy lifestyle

You can lose weight by eating a healthy diet and doing more physical activity. It’s not easy to make changes to your lifestyle but there are practical things you can do to achieve your weight-loss goals.

Medicines

There is no evidence that weight-loss medicines are more effective than having a healthy lifestyle.

Talk to your doctor about the effectiveness, risks, side effects and costs before making any decisions.

Surgery

You may be able to have bariatric surgery to reduce the size of your stomach so you feel full after eating small amounts of food.

Weight-loss surgery is only an option if you meet certain criteria, including:

  • having a BMI greater than 40 with unsuccessful attempts to lose weight for at least six months
  • having a BMI greater than 35 and other medical problems (e.g. diabetes or heart disease) with unsuccessful attempts to lose weight for at least 12 months.

Talk to your doctor about the benefits, risks and costs involved with surgery. Also, let your doctor know if you are planning to get pregnant in the future as there will be other things to consider.

Natural and complementary therapies

More than 70% of women with PCOS in Australia use natural and complementary therapies to improve their symptoms and general wellbeing. Common remedies include supplements (vitamins, minerals and fish oils) and herbal medicine (tea, tablets and liquids).

Research about the effectiveness of natural remedies for women with PCOS is limited.

Learn more about PCOS and natural therapies.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2023.

This con­tent has been reviewed by a group of med­ical sub­ject mat­ter experts, in accor­dance with Jean Hailes pol­i­cy.

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Last updated: 
07 December 2023
 | 
Last reviewed: 
29 May 2023

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